Characterization of hearing status in children under 3 years of age with cleft palate
Emily R Gallagher1, David Wu2, Erin Christianson3
1Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA.
Insights
Children with cleft palate often have mild to moderate hearing loss from infancy. Hearing improves significantly after palate repair and tympanostomy tube placement, highlighting the importance of timely intervention for better hearing outcomes.
Area of Science:
- Pediatric Otolaryngology
- Craniofacial Anomalies
- Audiology
Background:
- Cleft palate, with or without cleft lip, is associated with a higher incidence of hearing impairment.
- Early identification and management of hearing loss are crucial for speech and language development in affected children.
Purpose of the Study:
- To characterize the hearing thresholds in young children diagnosed with cleft palate (± cleft lip).
- To evaluate the impact of surgical intervention on hearing status in this pediatric population.
Main Methods:
- Retrospective analysis of 360 children with cleft palate (± cleft lip) born between 2008-2015.
- Hearing assessment using behavioral audiograms and brainstem auditory evoked responses (BAER) pre- and post-surgical palate repair.
- Data analysis grouped by test type and timing relative to palatoplasty and tympanostomy tube placement.
Main Results:
- Prior to palate repair, a significant proportion of children exhibited mild (33.5%) to moderate (31.1%) hearing loss.
- Brainstem auditory evoked response (BAER) testing in infants as young as 3 months indicated mild (45.9%) or moderate (29.7%) hearing loss.
- Following palatoplasty and tympanostomy tube placement, 86.0% of patients demonstrated normal hearing.
Conclusions:
- Hearing loss is prevalent in infants and young children with cleft palate, often presenting as mild to moderate.
- Surgical repair of the palate combined with tympanostomy tube insertion leads to significant hearing improvement.
- Further investigation is warranted to understand the long-term implications of transient hearing loss in early childhood.
Objectives:
To describe the hearing thresholds of children under 3 years of age with cleft palate with or without cleft lip.
Methods:
This retrospective study from a tertiary care children's hospital included children with cleft palate ± cleft lip born between January 01, 2008, and December 31, 2015. All patients who had the initial palate repair at our institution and at least one behavioral audiogram were included. Behavioral audiograms collected either in the sound field or under insert earphones showed results from the better hearing ear. We collected demographic information, cleft type, parent report of newborn hearing screen, syndrome diagnosis, comorbid conditions, and dates of tympanostomy tube placement and palatoplasty. The main outcome measure was hearing status as measured by behavioral audiograms, and, for a subset of patients, brainstem auditory evoked responses (BAER). Results were grouped by test type (behavioral vs BAER) and characteristics at time of testing (pre- or post-palatoplasty, with or without tympanostomy tube placement) to evaluate the range of severity of hearing loss.
Results:
Three hundred and sixty patients were included in the cohort. The cohort had two groups: Group 1 included 37 patients who had BAER results prior to surgery and behavioral audiogram results post-surgery; Group 2 included 322 patients who had behavioral audiograms pre-surgery (n = 206) and/or post-surgery (n = 215). The median age of patients at time of BAER in Group 1 was 3.00 months [IQR: 1.00,3.75]; pre-surgery BAER results showed mild (45.9%, n = 17) or moderate hearing loss (29.7%, n = 11) by this age. Patients in Group 2 with pre-surgery behavioral audiograms had a median age of 12.00 months [IQR: 11.00, 14.00] at time of audiogram. Most patients had a mild (33.5%, n = 69) or moderate hearing loss (31.1%, n = 64). Post-surgery, patients had a median age of 13.00 months [IQR: 11.00, 15.00] at time of hearing assessment and typically had normal hearing (86.0%, n = 185). In most patients, hearing improved after palate repair with concurrent tympanostomy tube placement.
Conclusions:
Most patients with cleft palate ± cleft lip had evidence of mild or moderate hearing loss prior to cleft palate repair, and hearing loss was evident from early infancy. Hearing improved after concurrent tympanostomy tube placement and palatoplasty. Further research is needed to understand the clinical significance of untreated transient hearing loss during the first year of life in this patient population.
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